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Nutrition IssuesNutrition Issues

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Normal Dietary requirement of protein 1g/Kg/Day Normal Dietary requirement of protein 1g/Kg/Day for adultsfor adults

Proteins provide 4 kcal (17kJ)/gram of proteinProteins provide 4 kcal (17kJ)/gram of protein

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9 Essential and 13 Non-Essential Amino Acids

1.1. HISTIDINEHISTIDINE2.2. ISOLEUCINEISOLEUCINE3.3. LEUCINELEUCINE4.4. LYSINELYSINE5.5. METHIONINEMETHIONINE6.6. PHENYLALANINEPHENYLALANINE7.7. THREONINETHREONINE8.8. TRYPTOPHANTRYPTOPHAN9.9. VALINEVALINE

1.1. ALANINEALANINE2.2. ARGININEARGININE3.3. ASPARGINEASPARGINE4.4. ASPARTIC ACIDASPARTIC ACID5.5. CYSTEINECYSTEINE6.6. GLYCINEGLYCINE7.7. CYSTINECYSTINE8.8. GLUTAMIC ACIDGLUTAMIC ACID9.9. PROLINEPROLINE10.10. HYDROXYPROLINEHYDROXYPROLINE11.11. TYROSINETYROSINE12.12. SERINESERINE13.13. GLUTAMINEGLUTAMINE

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Functions of Protein

Tissue growth,maintenance and repairTissue growth,maintenance and repair After anabolic needs are met excess of proteins After anabolic needs are met excess of proteins

are catabolized for energyare catabolized for energy After the energy requirements are met the After the energy requirements are met the

aminoacids are used to synthesize aminoacids are used to synthesize carbohydrates and fatscarbohydrates and fats

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Final Products of Protein Catabolism

CO2 and WaterCO2 and Water High energy molecule (ATP)High energy molecule (ATP) UreaUrea AmmoniaAmmonia (Note creatinine is derived from creatine and Uric (Note creatinine is derived from creatine and Uric

acid is derived from purines)acid is derived from purines)

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Individual functions of AA

GlycineGlycine- - synthesizes purines-porphyrins-creatinine-synthesizes purines-porphyrins-creatinine-glutathione-conjugated bile salts. Eliminates toxins in liverglutathione-conjugated bile salts. Eliminates toxins in liver

Glutamic acid- Glutamic acid- metabolism of ammonia, formation of metabolism of ammonia, formation of GABA. Important AA in wheat (gliadin), in MSG flavor GABA. Important AA in wheat (gliadin), in MSG flavor enhancerenhancer

Phenylalanine and Tyrosine-Phenylalanine and Tyrosine- hormone precursor hormone precursor epinephrine, norepinephrine and thyroxin, melaninepinephrine, norepinephrine and thyroxin, melanin

HistidineHistidine- - essential for infant, only essential in uremic adults. essential for infant, only essential in uremic adults. Precursor for histaminePrecursor for histamine

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Individual functions of AA

Tryptophan- Tryptophan- precursor of nicotinic acid and precursor of nicotinic acid and serotonin (5-HT)serotonin (5-HT)

Proline and hydroxyproline- Proline and hydroxyproline- porphyrines and B12porphyrines and B12

Arginine- Arginine- essential for urea formation in liver essential for urea formation in liver (ornithine-arginine (urea-cycle)(ornithine-arginine (urea-cycle)

Cysteine, cystine, methionine- Cysteine, cystine, methionine- principal source principal source for sulfur, synthesis of choline, and creatinefor sulfur, synthesis of choline, and creatine

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Individual functions of AA

Taurine- Taurine- synthesized from dietary cysteine or methionine synthesized from dietary cysteine or methionine ( concern in formula fed infants may develop taurine ( concern in formula fed infants may develop taurine deficiency) Human milk is rich in taurinedeficiency) Human milk is rich in taurine

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Carbohydrates- classified by number of sugar units they contain

MonoMono DiDi Oligo -3-10Oligo -3-10 PolysaccharidesPolysaccharides Major source of food energy Major source of food energy 4 kacl/g (17 kJ/g)4 kacl/g (17 kJ/g) Protein sparingProtein sparing

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Classification of Carbohydrates (CHO)

COMPLEX CHO COMPLEX CHO Oligo Oligo saccharidessaccharides

SourcesSources RemarksRemarks

Alpha-Alpha-galactosidesgalactosides

Soybeans and other legumes, Soybeans and other legumes, Non digestible sugarsNon digestible sugars

Fructo-Fructo-oligosacchardioligosacchardieses

Jerusalem artichokes, chicory, onionJerusalem artichokes, chicory, onion Non digestible sugarsNon digestible sugarsBifidogenic effectsBifidogenic effects

PolysaccharidesPolysaccharidesDigestibleDigestibleGlycogenGlycogen

Meat products and sea foodsMeat products and sea foods Polysaccharides of animal body Polysaccharides of animal body mainly in liver and musclesmainly in liver and muscles

StarchStarch Cereal grains, umripe fruits, Cereal grains, umripe fruits, vegetables, legumes and tubersvegetables, legumes and tubers

Most important food source of Most important food source of CHO in plants, composed CHO in plants, composed chiefly of amylose and chiefly of amylose and amylopectin, completely amylopectin, completely hydrolyzable to glucose. hydrolyzable to glucose.

        

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Classification of Carbohydrates (CHO)Complex CHO

PolysaccharidesPartially Digestible:

Sources Remarks

Inulin Tubers and roots of dahlias, artichokes, dandelions, onions and garlic

Hydrolyzed to fructose, used in investigation of renal GFR

Mannosan Legumes and plant gums Hydrolyzable to mannose but digestion is incomplete, but further splitting by bacteria in the large intestine may occur

Indigestible: Cellulose

Skins of fruits, outer coverings of seeds, and stalks and leaves of vegetables

Not subject to attack of digestive enzyme in man. Provides ‘bulk’ in the diet. Partially split into glucose by bacteria in large intestine

Hemicellulose Pectins, woody fibers, and leaves

Less polymerized than cellulose. May be digested by gut microbial enzymes, to yield xylose

Gum Hydrocolloids secreted at site of plant injury

Galactose and glucuronic acid predominat. Gum arabic is the most common hydrolyzed food additive.

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SorbitolSorbitol Synthesized from glucoseSynthesized from glucose No effect on blood glucoseNo effect on blood glucose Used in diabetic foodsUsed in diabetic foods

MannitolMannitol Used as drying agent for Used as drying agent for

certain foodscertain foods

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Oligosaccharides

Alpha-galactosideAlpha-galactoside Found in soybeans and Found in soybeans and

legumeslegumes Not digestedNot digested 100% fermented in colon- 100% fermented in colon-

increases SCFA, fecal increases SCFA, fecal output, and prebiotic output, and prebiotic effectseffects

Fructo-oligosaccharidesFructo-oligosaccharides Jerusalem artichoke, Jerusalem artichoke,

chicory, onionchicory, onion Reduced calorific value not Reduced calorific value not

digesteddigested PrebioticPrebiotic Stimulate intestinal Stimulate intestinal

bifidobacteriabifidobacteria

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Role of minerals Role of minerals and vitamins inand vitamins in Gluocse metabolism-Gluocse metabolism- MagnesiumMagnesiumPhosphorusPhosphorusThiamin (B1)Thiamin (B1)Riboflavin (B2) Riboflavin (B2) Niacin (B3)Niacin (B3) Pyridoxine (B6)Pyridoxine (B6)Pantothenic acidPantothenic acid

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Carb facts

Simple carbohydrates found Simple carbohydrates found in fruits, vegetables and in fruits, vegetables and milkmilk

Refined sugars are ‘added’ Refined sugars are ‘added’ sugarssugars

Complex carbohydrates Complex carbohydrates found in grains, tubers and found in grains, tubers and legumeslegumes

Carbohydrate drops off as Carbohydrate drops off as fat content increasesfat content increases

In rich countries there is a In rich countries there is a decrease in complex and decrease in complex and increase in simple sugars increase in simple sugars due to increased use of due to increased use of processed foodprocessed food

?Solution ?Solution keep fat in the diet less keep fat in the diet less

than 30%than 30% Keep carbs 50-65% Keep carbs 50-65%

substantial ones being substantial ones being complex sugars and fiberscomplex sugars and fibers

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Carb Disorders: Lactose/Sucrose/Galactosemia/ DM

Lactose Intolerance- Adult onset-Afro-Asian-Lactose Intolerance- Adult onset-Afro-Asian-Mediterranean ethnicityMediterranean ethnicityAvoid milk/ Cheese-Yogurt betterAvoid milk/ Cheese-Yogurt better

Sucrose Intolerance-avoid table sugar, highly Sucrose Intolerance-avoid table sugar, highly sweetened foodssweetened foods

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Disorders of Carbs!

Lactose intoleranceLactose intolerance Sucrose intoleranceSucrose intolerance Galactosemia- vomiting, liver damage, growth Galactosemia- vomiting, liver damage, growth

retardation and cataractsretardation and cataracts Diabetes MellitusDiabetes Mellitus

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Nutrition goals for DM patients

Balance food intake with insulin to maintain normal Balance food intake with insulin to maintain normal glucose levelsglucose levels

Achieve optimal lipid levelsAchieve optimal lipid levels Provide adequate calories for weight maintenance Provide adequate calories for weight maintenance

/growth/growth Prevent or control nutrition related risk factors- Prevent or control nutrition related risk factors-

obesity, lipids, HTNobesity, lipids, HTN Improve overall health by optimal nutritionImprove overall health by optimal nutrition

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Nutrition goals for IDDM (T1) patients

~60% of total energy from carbs~60% of total energy from carbs 12-20% of energy from proteins12-20% of energy from proteins Less than 10% from fatsLess than 10% from fats Up to 10% (6-8%) of total energy from Up to 10% (6-8%) of total energy from

polyunsaturated fatpolyunsaturated fat Limit daily cholesterol to 300-200 mg Limit daily cholesterol to 300-200 mg

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Too much fiber? Caution!

Excessive fiber in the diet can reduce mineral Excessive fiber in the diet can reduce mineral absorption resulting in negative balance of iron, zinc absorption resulting in negative balance of iron, zinc and other trace elements. It can interfere with and other trace elements. It can interfere with consumption of a balanced diet.consumption of a balanced diet.

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?Artificial Sweeteners

43lbs of sugar per year (10-12% of energy intake)- 43lbs of sugar per year (10-12% of energy intake)- Dental issues and DMDental issues and DM

SaccahrinSaccahrin AspartameAspartame Acesulfane-KAcesulfane-K Sucrose polymersSucrose polymers

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saccharin

A petroleum by product 200-700 times sweeterA petroleum by product 200-700 times sweeter ?Bladder cancer?Bladder cancer Pregnant women and children –AVOID saccharin Pregnant women and children –AVOID saccharin

containing canned drinkscontaining canned drinks

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aspartame aspartame Dipeptide of aspartic acid and phenylalanine (180 Dipeptide of aspartic acid and phenylalanine (180

times sweeter)times sweeter) Safety concernsSafety concerns acesulfame-kacesulfame-k (200 times sweeter)(200 times sweeter) sucrose polymers sucrose polymers by chlorination of sucrose 600 by chlorination of sucrose 600

times sweeter very populartimes sweeter very popular

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XYLITOL

a safe sweetener for a safe sweetener for people with diabetespeople with diabetes

produced by produced by hydrogenation of xylosehydrogenation of xylose

dental heath benefits in dental heath benefits in caries prevention caries prevention

may help prevention of may help prevention of osteoporosisosteoporosis

reduce ear infections-ear reduce ear infections-ear wax-wax-

Increases gut SCFAIncreases gut SCFA

Increases energy by enhancing Increases energy by enhancing ATP production ATP production

Increases utilization of fat Increases utilization of fat Replenishes glycogen Replenishes glycogen Anabolic — keeps biosynthetic Anabolic — keeps biosynthetic

pathways open pathways open Anticatabolic —helps maintain Anticatabolic —helps maintain

lean muscle mass lean muscle mass Antioxidant —generates NADPH, Antioxidant —generates NADPH,

keeping glutathione in an active keeping glutathione in an active state state

Increases endurance Increases endurance Reduces free radical and oxidative Reduces free radical and oxidative

damage damage

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LIPIDS aka FAT

Insoluble in water Insoluble in water Soluble in non-polar stateSoluble in non-polar state High energy valueHigh energy value Deliver fat soluble vitamins, essential fatty acids-Deliver fat soluble vitamins, essential fatty acids-

triglycerides-pospholipids-sphingolipids-sterols-triglycerides-pospholipids-sphingolipids-sterols-waxes-glycolipids-lipoproteinswaxes-glycolipids-lipoproteins

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Number of carbon atoms

Classified as Classified as Short chain (C4-6)Short chain (C4-6) Medium chain (5-12)Medium chain (5-12) Long chain (12 or more)Long chain (12 or more) ““Saturated “ fatty acids- palmitic and stearic acidsSaturated “ fatty acids- palmitic and stearic acids Mono-unsaturated fatty acid- oleic acidMono-unsaturated fatty acid- oleic acid

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Poly unsaturated fatty acids

Linoleic acid - essentialLinoleic acid - essential Linolenoic acid - essentialLinolenoic acid - essential Arachidonic acidArachidonic acid

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Fat Facts

Cholesterol only in animal cellsCholesterol only in animal cells Ergosterol in plant cellsErgosterol in plant cells Waxes are in plants and fruits but not in land animal Waxes are in plants and fruits but not in land animal

speciesspecies Most concentrated source of energy!Most concentrated source of energy! 9 kcal/g (37kJ/g)9 kcal/g (37kJ/g) Makes food palatable/ gives aromaMakes food palatable/ gives aroma

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Fat Facts

Essential fatty acids are required –Essential fatty acids are required – GrowthGrowth ReproductionReproduction Skin integritySkin integrity Utilization of fat/ cell membrane maintenanceUtilization of fat/ cell membrane maintenance Prostaglandin precursorsProstaglandin precursors

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Fat Facts

Industrial countries diet energy source is 38% Industrial countries diet energy source is 38% fat. This is very high.fat. This is very high.

Evidence for an effect of dietary cholesterol on Evidence for an effect of dietary cholesterol on blood cholesterol is inconclusiveblood cholesterol is inconclusive

Foods that have a high cholesterol content Foods that have a high cholesterol content include: include: liver, egg yolk, kidney, brains, liver, egg yolk, kidney, brains, sweetbreads, shellfish and fish roesweetbreads, shellfish and fish roe

.

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Fat Facts

Peanut oil and olive oil are examples of fats which Peanut oil and olive oil are examples of fats which are rich in the monounsaturated fatty acid, oleic are rich in the monounsaturated fatty acid, oleic acid.acid.

Monounsaturated fatty acids Monounsaturated fatty acids in the diet have a in the diet have a lowering effect on LDL cholesterollowering effect on LDL cholesterol

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Fat Facts: Trans Fatty Acids

Trans unsaturated fatty acids are produced Trans unsaturated fatty acids are produced commercially in large amounts to form shortening commercially in large amounts to form shortening and margarines.and margarines.

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omega-3 (n-3) (α-linolenic acid), omega-6 (n-6) fatty acids Is it essential?Is it essential?

role as structural components of biological membranes- role as structural components of biological membranes- retina, brainretina, brain

the long chain n-3 and n-6 fatty acids are precursors of the long chain n-3 and n-6 fatty acids are precursors of prostaglandins, prostacyclins, thromboxanes and leuko-prostaglandins, prostacyclins, thromboxanes and leuko-trienestrienes

Also synthesize arachidonic acid and docosahexanoic acid Also synthesize arachidonic acid and docosahexanoic acid (DHA)(DHA)

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Role of DHA

Part of phospholipids. Part of phospholipids. Very high levels are found in the retina, cerebral cortex, Very high levels are found in the retina, cerebral cortex,

testes and spermtestes and sperm DHA in the diet improves learning ability as well as visual DHA in the diet improves learning ability as well as visual

acuity. acuity. Availability of dietary DHA is critical for the development of Availability of dietary DHA is critical for the development of

preterm infants, since DHA uptake by brain and retina preterm infants, since DHA uptake by brain and retina increases substantially during the last trimester of pregnancyincreases substantially during the last trimester of pregnancy

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?DHA deficiency

Associated with: Associated with: 1.1. fetal alcohol syndromefetal alcohol syndrome2.2. attention deficit hyperactivity disorderattention deficit hyperactivity disorder3.3. cystic fibrosiscystic fibrosis4.4. phenylketonuriaphenylketonuria5.5. unipolar depressionunipolar depression6.6. aggressive hostility andaggressive hostility and7.7. adrenoleukodystrophy adrenoleukodystrophy A decrease in DHA in the brain may beA decrease in DHA in the brain may be

associated with cognitive decline during aging and with associated with cognitive decline during aging and with onset of sporadic Alzheimer's diseaseonset of sporadic Alzheimer's disease ..

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Role of fish and fish oils- high in EPA (eicosa pentanoic acid) and DHA (docosa hexanoic acid)

Beneficial in-hypertension, hyperlipidemia, Beneficial in-hypertension, hyperlipidemia, thrombosis, coronary heart disease and thrombosis, coronary heart disease and immunological disordersimmunological disorders

Lowers TriglyceridesLowers Triglycerides Omega-3 fatty acids tend to increase bleeding time by Omega-3 fatty acids tend to increase bleeding time by

inhibiting platelet aggregationinhibiting platelet aggregation Eating 4 to 6 ounces (120-170 g) of fish several times a Eating 4 to 6 ounces (120-170 g) of fish several times a

week is helpfulweek is helpful

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Treatment of Hyperlipidemias:

❑ ❑ decreased total fatdecreased total fat ❑ ❑ decreased saturated fatdecreased saturated fat ❑ ❑ decreased energy intakedecreased energy intake ❑ ❑ limited cholesterol intakelimited cholesterol intake ❑ ❑ limited simple sugar intakelimited simple sugar intake ❑ ❑ increased complex carbohydratesincreased complex carbohydrates ❑ ❑ moderate alcohol consumptionmoderate alcohol consumption

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Fat Alert

High levels of certain dietary fat are thought to High levels of certain dietary fat are thought to increase the risk of many types of cancer, increase the risk of many types of cancer, especially colon, lung, ovary and prostate especially colon, lung, ovary and prostate cancerscancers

omega-3 fatty acids may protectomega-3 fatty acids may protect reduce cancer risk include limiting the total fat reduce cancer risk include limiting the total fat

intake and using vegetable oil instead of intake and using vegetable oil instead of animal fatanimal fat

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?Vitamins

Organic compounds essential in small quantities Organic compounds essential in small quantities for the normal metabolismfor the normal metabolism

cannot be synthesized by the body and must be cannot be synthesized by the body and must be obtained from the dietobtained from the diet

no one food contains all of themno one food contains all of them classified according to their solubility in water classified according to their solubility in water

and fat solventsand fat solvents

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The fat solubleThe fat soluble vitamins vitamins include: include: vitamin A (retinol)vitamin A (retinol)vitamin D (calciferol)vitamin D (calciferol)vitamin E (tocopherol) andvitamin E (tocopherol) andvitamin K (menadione)vitamin K (menadione)

stored in appreciablestored in appreciableamounts in body tissues and, amounts in body tissues and, do not have to be supplied do not have to be supplied dailydaily

Habitual intake of excessive Habitual intake of excessive amounts of fat soluble amounts of fat soluble vitamins isvitamins istoxic.toxic.

The water solubleThe water soluble vitamins vitamins include:include:vitamin B1 (thiamin), vitamin B2 vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), (riboflavin), vitamin B3 (niacin), biotin, biotin, vitamin B6 (pyridoxine), pantothenic vitamin B6 (pyridoxine), pantothenic acid,acid,folate, folate, vitamin B12 (cobalamin) and vitamin B12 (cobalamin) and vitamin C (ascorbic acid).vitamin C (ascorbic acid).

not stored to any greatnot stored to any greatextent and therefore need to be extent and therefore need to be included in the diet every dayincluded in the diet every day

Some Toxicity reported in very high Some Toxicity reported in very high dosesdoses

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Vitamin A

Stored as preformed Stored as preformed retinolretinol

Plant sources-Plant sources-carotenoidscarotenoids (Beta-(Beta-carotene,alpha-carotene, carotene,alpha-carotene, lutein, and lycopene are lutein, and lycopene are found in human plama)found in human plama)

Food Sources- (IU/100g)Food Sources- (IU/100g) Butter-3058Butter-3058 Cheese-1059Cheese-1059 Carrot, raw-28129Carrot, raw-28129 Apricots- 2619Apricots- 2619 Liver-Liver- Beef -36106Beef -36106 Lamb -25998Lamb -25998 Chicken-16375Chicken-16375 Halibut- 179Halibut- 179 Sardines-224Sardines-224

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Vitamin A TOXICITY

Excessive ingestion of carotenoids,-not toxic to manExcessive ingestion of carotenoids,-not toxic to manresults in carotenemia and yellow discoloration of results in carotenemia and yellow discoloration of the skinthe skin

Chronic toxicity-Chronic toxicity- anorexia, nausea, vomiting, abdominal pain, dry skin, anorexia, nausea, vomiting, abdominal pain, dry skin, rashes, headaches, loss of hair, abnormal skin rashes, headaches, loss of hair, abnormal skin pigmentation, increased fragility and pain in the long pigmentation, increased fragility and pain in the long bones, menstrual irregularities and enlargement of the bones, menstrual irregularities and enlargement of the liver and spleenliver and spleenSafe dose not to exceed – Safe dose not to exceed – 10,000 IU for children or 10,000 IU for children or 25,000 IU for adults25,000 IU for adults

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vit A cancer benefits-

maintains epithelial tissuesmaintains epithelial tissues tumor surveillance by the immune system is tumor surveillance by the immune system is

dependent on adequate levels of vitamin Adependent on adequate levels of vitamin A gene expression may be directly influenced by gene expression may be directly influenced by

vitamin A and retinoids.vitamin A and retinoids. Beta carotene is an antioxidantBeta carotene is an antioxidant

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Vitamin D

Essential for calcium Essential for calcium homeostasis (a hormone and homeostasis (a hormone and prehormone)prehormone)

precursor or provitamin D precursor or provitamin D (ergosterol (plants)* and (ergosterol (plants)* and

7-dehydrocholesterol** (in the 7-dehydrocholesterol** (in the skin) with ultraviolet light skin) with ultraviolet light exposure requiredexposure required

*converts to D2 (ergocalciferol)*converts to D2 (ergocalciferol) **converts to D3 (liver) **converts to D3 (liver)

(prehormone) (cholecalciferol)(prehormone) (cholecalciferol) 1.25-dihydroxy D3 (hormone) 1.25-dihydroxy D3 (hormone)

(kidney) which then acts upon (kidney) which then acts upon its target tissues (intestine, bone its target tissues (intestine, bone and kidney) to regulate calcium and kidney) to regulate calcium and phosphorus absorption and and phosphorus absorption and metabolismmetabolism

Food Sources- (IU/100g)Food Sources- (IU/100g) Egg 52Egg 52 Cheese 12Cheese 12 Cow’s milk 40 (100ml)Cow’s milk 40 (100ml) Sardines 272Sardines 272 Salmon 624Salmon 624 Livers- 50-65Livers- 50-65 Codliver oil 16,700Codliver oil 16,700

Breast milk is low in vitamin D

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vit D TOXICITY

Habitual intake of excessive vitamin D Habitual intake of excessive vitamin D is toxic. is toxic.

The symptoms include nausea, The symptoms include nausea, anorexia, polyuria, pruritis and anorexia, polyuria, pruritis and calcification ofcalcification of

soft tissues such as the kidney and heart. soft tissues such as the kidney and heart. In infants can result in bossing of the In infants can result in bossing of the

skull, mental retardation and death. skull, mental retardation and death. Mild vitamin D toxicity is manifested Mild vitamin D toxicity is manifested

in elevated serum calcium levels.in elevated serum calcium levels. Recommended daily intake:Recommended daily intake:

(400 IU) cholecalciferol.(400 IU) cholecalciferol.Avoid intakes above Avoid intakes above (3200 IU) cholecalciferol(3200 IU) cholecalciferol

Benefits-Benefits- can reduce the risk of can reduce the risk of

osteoporosisosteoporosis may be important in may be important in

regulating blood regulating blood pressure and improving pressure and improving some forms of some forms of hypertensionhypertension

anticarcinogenic effect anticarcinogenic effect in colon carcinogenesisin colon carcinogenesis

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vitamin E

Alpha-tocopherol- function Alpha-tocopherol- function not fully knownnot fully known

May function as an May function as an antioxidant by reducing the antioxidant by reducing the free radicals free radicals

(other enzymes involved :(other enzymes involved :glutathione peroxidase, catalase andglutathione peroxidase, catalase andsuperoxide dismutase)superoxide dismutase)

Food sources- oils-Food sources- oils- Wheat germ 192.4Wheat germ 192.4 Soybean 18.2Soybean 18.2 Nuts-Nuts- Almonds 5.6Almonds 5.6 Filbert 23.9Filbert 23.9

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vit E TOXICITY

RareRare A vitamin K inhibitor A vitamin K inhibitor and can prolong and can prolong clotting timeclotting time Can cause bruisingCan cause bruisingbleedingbleeding No proven benefitsNo proven benefits Safe dose 400 unitsSafe dose 400 units

Food Sources-Food Sources- Spinach/ Turnips/ Spinach/ Turnips/

Broccoli 1.9-1.7Broccoli 1.9-1.7 Butter 1.6Butter 1.6 Chicken 1.3Chicken 1.3 Fish- Halibut 1.1Fish- Halibut 1.1

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vitamin K

sources of vitamin K are sources of vitamin K are green leafy vegetables such green leafy vegetables such as cabbage and spinachas cabbage and spinach

half of the human supply of half of the human supply of vitamin K is derived from vitamin K is derived from bacterial synthesis in the bacterial synthesis in the intestine, absorbed from the intestine, absorbed from the lower intestine and colonlower intestine and colon

Food Sources (mg/100g)Food Sources (mg/100g) Broccoli 270Broccoli 270 Spinach 400Spinach 400 Lettuce 122Lettuce 122 Cabbage 145Cabbage 145

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Water Soluble vitamins: The B group (B-complex) Thiamine (B1)

A coenzymeA coenzyme thiamin pyrophosphate thiamin pyrophosphate

(TPP) is involved in (TPP) is involved in energy metabolismenergy metabolism

Milling of grains removes Milling of grains removes those portions which are those portions which are the richest in thiamin the richest in thiamin (the endosperm, the (the endosperm, the aleurone layer and the aleurone layer and the bran).bran).

Food SourcesFood Sources Wheat germ 1.86Wheat germ 1.86 Bran flakes 1.3Bran flakes 1.3

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?Get more vitamin B1

Cooking removes thiamineCooking removes thiamine Conserved when consumed without excessive Conserved when consumed without excessive

cooking (enriched bread, breakfast cereals). cooking (enriched bread, breakfast cereals). Parboiling of rice facilitates retention of some of Parboiling of rice facilitates retention of some of

the thiaminthe thiamin Main site of thiamin absorption is the jejunumMain site of thiamin absorption is the jejunum Absorption is decreased by folate deficiency and Absorption is decreased by folate deficiency and

alcoholismalcoholism

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Thiamine deficiency (Beriberi)

Thiamin deficiency affects the cardiovascular, Thiamin deficiency affects the cardiovascular, muscular, nervous and gastrointestinal systems. muscular, nervous and gastrointestinal systems.

The earliest manifestation of thiaminThe earliest manifestation of thiamindeprivation includes anorexia, fatigue, depression, deprivation includes anorexia, fatigue, depression,

irritability, poor memory, inability to concentrate and irritability, poor memory, inability to concentrate and vague abdominal and cardiac complaints.vague abdominal and cardiac complaints.

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Alcoholics and Lack of Thiamine

Polyneuropathy (factors other than thiamin Polyneuropathy (factors other than thiamin deficiency may also be involved)deficiency may also be involved)Wernicke’s disease (signs Wernicke’s disease (signs opthalmoplegia,nystagmus opthalmoplegia,nystagmus and ataxia)and ataxia) Korsakoff’s psychosis (signs are memory defect Korsakoff’s psychosis (signs are memory defect and and confabulation) and confabulation) and Amblyopsia (dim vision).Amblyopsia (dim vision).

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Water Soluble vitamins: The B group (B-complex) Riboflavin (B2)

Significant losses of Significant losses of riboflavin can occur by riboflavin can occur by exposure to lightexposure to light

Coenzyme activity in Coenzyme activity in Krebs cycleKrebs cycle

Food Sources-Food Sources- Beef liver 2.8Beef liver 2.8

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Riboflavin deficiency

cheilosis, angular stomatitis, glossitis, seborrheic cheilosis, angular stomatitis, glossitis, seborrheic dermatitis and ocular manifestations:dermatitis and ocular manifestations:

photophobia, itching, burning and circumcorneal photophobia, itching, burning and circumcorneal capillary engorgement. capillary engorgement.

The seborrheic dermatitis is usually found in the The seborrheic dermatitis is usually found in the nasolabial region, near the inner and outer canthi nasolabial region, near the inner and outer canthi of the eyes, behind the ears and on the posterior of the eyes, behind the ears and on the posterior surface of the scrotumsurface of the scrotum

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Water Soluble vitamins: The B group (B-complex) B3 (Niacin)

Niacin functions in Niacin functions in energy metabolism energy metabolism in the amide form as in the amide form as part of the part of the coenzymes- coenzymes- glycolysis, the Krebs glycolysis, the Krebs cyclecycle

Food Sources-Food Sources- Chicken 9.2Chicken 9.2 Roast lamb 4.6Roast lamb 4.6 Salmon 6.5Salmon 6.5 Veal 9.9Veal 9.9 Peanuts roasted 13.5Peanuts roasted 13.5 Whole wheat flour 6.4Whole wheat flour 6.4

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Niacin deficiency: Pellagra4 D’s-dermatitis, diarrhea, dementia and death

Usually Usually associated with associated with diets baseddiets based

chiefly on corn and chiefly on corn and proteins proteins containing containing inadequate inadequate amounts ofamounts of

tryptophan.tryptophan.

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Niacin Megadoses(3-6 g/day) Toxicity

Niacin lowers cholesterol Niacin lowers cholesterol Niacinamide does not lower cholesterolNiacinamide does not lower cholesterol Toxicity: Toxicity: Short term-vasodilation, burning or stinging sensations in Short term-vasodilation, burning or stinging sensations in

the face and hands, nausea, vomiting, and diarrhea.the face and hands, nausea, vomiting, and diarrhea. In the longer term- varying degrees of hyperpigmentation of In the longer term- varying degrees of hyperpigmentation of

the skin, abnormal glucose tolerance, hyperuricemia, peptic the skin, abnormal glucose tolerance, hyperuricemia, peptic ulcers, hepatomegaly, and jaundiceulcers, hepatomegaly, and jaundice

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BIOTIN

required for carbohydrate required for carbohydrate and fat metabolism- and fat metabolism- coenzyme in coenzyme in gluconeogenesis and Krebs gluconeogenesis and Krebs cyclecycle

biotin deficiency: namely biotin deficiency: namely decreased protein synthesis decreased protein synthesis andand

hypercholesterolemiahypercholesterolemia

Food Sources:Food Sources: Liver, Chicken 170Liver, Chicken 170 Banana 2.6Banana 2.6 Oatmeal 21Oatmeal 21

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Biotin Deficiency Features

Scaly dermatitis, grayish pallor, extreme lassitude, Scaly dermatitis, grayish pallor, extreme lassitude, anorexia, nausea, anemia, depression, muscle pain, anorexia, nausea, anemia, depression, muscle pain, parethesia, hypercholesterolemia and parethesia, hypercholesterolemia and electrocardiogram changeselectrocardiogram changes

Seen with bizarre food habits, i.e. consumption of large Seen with bizarre food habits, i.e. consumption of large quantities of raw egg whites and little else. Seborrheic quantities of raw egg whites and little else. Seborrheic dermatitis in infants under six months may be dermatitis in infants under six months may be responsive to biotin administration.responsive to biotin administration.

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Pantothenic acid deficiency

Abdominal pain and soreness, nausea, personality Abdominal pain and soreness, nausea, personality changes, insomnia, impaired adrenal function, changes, insomnia, impaired adrenal function, weakness and cramps in the legs, paresthesia of the weakness and cramps in the legs, paresthesia of the hands and feet and impaired antibody production.hands and feet and impaired antibody production.

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Water Soluble vitamins: The B group (B-complex) B6 (Pyridoxine)

active coenzyme form of active coenzyme form of pyridoxal phosphate (PLP)pyridoxal phosphate (PLP)

coenzyme in transamination, coenzyme in transamination, decarboxylation and decarboxylation and transulfuration reactions of transulfuration reactions of amino acids. amino acids.

involved in the synthesis of involved in the synthesis of the neurotransmitters the neurotransmitters serotonin and norepinephrineserotonin and norepinephrine

Food Sources-Food Sources- Brown rice 0.14Brown rice 0.14 Wheat flour 0.34Wheat flour 0.34 Beef liver 0.94Beef liver 0.94 Banana 0.58Banana 0.58

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B6 Deficiency

Seborrheic dermatitis, cheilosis, glossitis, stomatitis, Seborrheic dermatitis, cheilosis, glossitis, stomatitis, altered tryptophan metabolism, depression and altered tryptophan metabolism, depression and confusionconfusion

B6 deficiency in alcoholics may be as high as 20-30 %B6 deficiency in alcoholics may be as high as 20-30 % Up to one-fifth of oral contraceptive users show Up to one-fifth of oral contraceptive users show

biochemical evidence of vitamin B6 deficiencybiochemical evidence of vitamin B6 deficiency

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B6Toxicity

Oral doses of 1-150 mg/day of vitamin B6 have Oral doses of 1-150 mg/day of vitamin B6 have been used therapeutically without ill effectbeen used therapeutically without ill effect

A transient dependency has been induced in A transient dependency has been induced in adults given a supplement of 200 mgadults given a supplement of 200 mg

Cause ataxia and severe sensory-nervous system Cause ataxia and severe sensory-nervous system dysfunctiondysfunction

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B6 Health benefits

Reduces the symptoms of carpal tunnel Reduces the symptoms of carpal tunnel syndrome and premenstrual syndrome in some syndrome and premenstrual syndrome in some womenwomen

May decrease the frequency and severity of May decrease the frequency and severity of asthma attacks.asthma attacks.

Useful in homocystinuria and high circulating Useful in homocystinuria and high circulating homocysteine levels, as well as in diabetic homocysteine levels, as well as in diabetic neuropathy and in normal immune functionneuropathy and in normal immune function

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Vitamin C (Ascorbic Acid)

Absorption of vitamin C occurs in the jejunum and ileum

Relatively high concentrations of vitamin C are found in the retina and other eye tissues, the adrenal and pituitary glands, brain, pancreas, kidney, liver and spleen.

Food Sources-Food Sources- Kiwi fruit 96Kiwi fruit 96 Oranges 53/ Juice 34.4Oranges 53/ Juice 34.4 Broccoli 93Broccoli 93 Parsley 133Parsley 133 Red sweet peppers 190Red sweet peppers 190

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Deficiency of vitamin C

weak, spongy and bleeding gums

loose teeth, resorbed dentine, swollen tender joints, hemorrhage

rough skin, muscular aches and pains and irritability

impaired iron absorption, impaired folic acid, serotonin and adrenaline metabolism and psychological changes

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Vitamin C Megadose Toxicity

Gastrointestinal Gastrointestinal disturbances disturbances

UricosuriaUricosuria Excessive absorption of ironExcessive absorption of iron Impaired bactericidal Impaired bactericidal

activity of the leukocyteactivity of the leukocyte Interferes with urine Interferes with urine

glucose testingglucose testing

? Benefits:? Benefits: Cardiovascular health Cardiovascular health Blood pressureBlood pressure Platelets functionPlatelets function

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Dietary Goals

1.1. Enjoy a variety of foods/maintain a balanced dietEnjoy a variety of foods/maintain a balanced diet2.2. Maintain ideal weight by reducing excessive energy Maintain ideal weight by reducing excessive energy

consumption and increasing physical activityconsumption and increasing physical activity3.3. Reduce fat intake to no more than 30% of total energy Reduce fat intake to no more than 30% of total energy

with no more than 10% of total energy as saturated fat.with no more than 10% of total energy as saturated fat.4.4. Moderate consumption of alcoholModerate consumption of alcohol5.5. Limit intake of sugarLimit intake of sugar6.6. Avoid too much salt, andAvoid too much salt, and7.7. Increase intake of whole grain cereals, fresh fruit and Increase intake of whole grain cereals, fresh fruit and

vegetablesvegetables

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?Breast Milk

Exclusive breast feeding up to 6 months and longer!Exclusive breast feeding up to 6 months and longer! Complementary foods may be introduced from about Complementary foods may be introduced from about

6 months of age. 6 months of age. Exclusively breast fed infants follow a slower but Exclusively breast fed infants follow a slower but

normal growth pattern than bottle fed infants at normal growth pattern than bottle fed infants at around 4 to 6 months of age and may therefore around 4 to 6 months of age and may therefore require a separate growth curve.require a separate growth curve.

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Breast vs. Bottle (formula) feeds

contains digestive enzymes such as contains digestive enzymes such as amylase and lipaseamylase and lipase

contains immunologiccontains immunologicsubstances such as IgA, lactoferrin, substances such as IgA, lactoferrin,

lysozymes, macrophages and other lysozymes, macrophages and other antibodies that confer passive antibodies that confer passive immunityimmunity

lactobacillus factor present in breast lactobacillus factor present in breast milkmilk

less susceptible to respiratory, less susceptible to respiratory, enteric and ear infections.enteric and ear infections.

not presentnot present does not encourage lactobacilli does not encourage lactobacilli

colonization- predisposes to colonization- predisposes to respiratory, enteric and ear respiratory, enteric and ear infectionsinfections

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Breast milk-Long term Benefits! breastfed infants may have reduced risk of-breastfed infants may have reduced risk of-

diabetes mellitus, diabetes mellitus, certain types of cancer andcertain types of cancer and raised serum cholesterol later in liferaised serum cholesterol later in life TRIPLE BENEFITS of Breast feeding-TRIPLE BENEFITS of Breast feeding-

1.1.Breast milk is readily available, relatively Breast milk is readily available, relatively safe and enhances intestinal safe and enhances intestinal developmentdevelopment

2.2.Breastfeeding is satisfying for both the Breastfeeding is satisfying for both the mother and child. mother and child.

3.3.The closeness of this coupling enhances The closeness of this coupling enhances maternal-infant bondingmaternal-infant bonding

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When to start cow’s milk?

delay the introduction of cow’sdelay the introduction of cow’smilk to between 9 and 12 monthsmilk to between 9 and 12 monthsReason:Reason: High protein content and the accompanying renal solute High protein content and the accompanying renal solute

load in cow’s milk; load in cow’s milk; the risk of an allergic reaction; and the risk of a blood-the risk of an allergic reaction; and the risk of a blood-

losing enteropathy in some infants that is induced by a losing enteropathy in some infants that is induced by a heat-labile factorin the proteinheat-labile factorin the protein

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Signs of food allergy in children

Systemic:Systemic: anaphylaxis (allergic shock reaction) anaphylaxis (allergic shock reaction) Gastrointestinal:Gastrointestinal: vomiting, abdominal pain, vomiting, abdominal pain,

diarrhea,malabsorption, enteropathies;diarrhea,malabsorption, enteropathies; Respiratory:Respiratory: rhinitis, sinusitis, secretory otis media, rhinitis, sinusitis, secretory otis media,

cough, wheezing, pulmonary infiltration;cough, wheezing, pulmonary infiltration; Cutaneous:Cutaneous: rash, uticaria, eczema. rash, uticaria, eczema.

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Gluten Sensitivity

Gluten sensitive enteropathy, more commonly Gluten sensitive enteropathy, more commonly known as celiac disease, is a food allergyknown as celiac disease, is a food allergy

affects children and is life-lastingaffects children and is life-lasting need a diet which eliminates gluten and need a diet which eliminates gluten and

gluten-containing products for the patient's gluten-containing products for the patient's lifetime.lifetime.

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Obesity: ‘defined as 20% above the ideal weight’

Risk factor for-Risk factor for- diabetes mellitus,diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, hypertension, hyperlipidemia, coronary artery disease, obstructive sleep apnea, and obstructive sleep apnea, and CancerCancer cause: nutrition transition to fat-rich diets and cause: nutrition transition to fat-rich diets and

reduced physical activity reduced physical activity In developed countries, poverty is associated with In developed countries, poverty is associated with

increased prevalence, whereas in developing increased prevalence, whereas in developing countries it is the relatively affluent classcountries it is the relatively affluent class

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?Too fat

Over fatness has been defined Over fatness has been defined as a percent body fat as a percent body fat compositioncomposition than 20 for men and than 20 for men and greater than 30 for womengreater than 30 for women

Obesity GradeObesity Grade BMIBMI

Class IIIClass III ≥≥4040

Class IIClass II 35-39.935-39.9

Class IClass I 30-34.930-34.9

OverweightOverweight 25-29.925-29.9

NormalNormal 18.5-24.918.5-24.9

Thinness Thinness (Protein Malnutrition)(Protein Malnutrition)

≤≤18.518.5

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?weight Reduction- Rapid vs. Sensible

If input is less than output, weight loss occurs!If input is less than output, weight loss occurs! A multi-step process, beginning with food intake A multi-step process, beginning with food intake

>digestion>absorption>systemic transport> >digestion>absorption>systemic transport> cellular uptake and finally> storage and utilization. cellular uptake and finally> storage and utilization.

Alteration in any one step can change the net Alteration in any one step can change the net result.result.

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EXERCISE!

Activity Activity Kcal/min/kgKcal/min/kg BasketballBasketball 99 Cycling at 9.4 mphCycling at 9.4 mph 6.56.5 Dancing (twist)Dancing (twist) 10.910.9 FootballFootball 8.68.6 Running 8 min/mileRunning 8 min/mile 13.613.6 Sitting quietlySitting quietly 1.41.4 WalkingWalking 5.25.2 VacuumingVacuuming 33 IroningIroning 2.1-4.2 (F:M)2.1-4.2 (F:M)

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Useful tools:

Weight Watchers InternationalWeight Watchers International Shape Up America (http//www.shapeup.org)Shape Up America (http//www.shapeup.org)

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Soluble Dietary Fibers

Soluble fibers include pectin, resistant starches and other Soluble fibers include pectin, resistant starches and other polysaccharides.polysaccharides.

They are not digested in the small intestine increaseThey are not digested in the small intestine increase The transit time through the gut, delay gastric emptying, and The transit time through the gut, delay gastric emptying, and

slow glucose absorption. slow glucose absorption. They can be degraded by colonic bacteria andThey can be degraded by colonic bacteria and Thus lower luminal pH, stimulate proliferation of colonic Thus lower luminal pH, stimulate proliferation of colonic

microflora (microflora (prebiotic prebiotic effect) and produce short chain fatty effect) and produce short chain fatty acids (SCFA) such as acetic, butyric and propionic acid.acids (SCFA) such as acetic, butyric and propionic acid.

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SCFA benefits?

Provide nourishment to the colonProvide nourishment to the colon Fruits, vegetables and oats are the main dietary Fruits, vegetables and oats are the main dietary

sources of soluble fibersources of soluble fiber 50% fiber intake from grains, 50% fiber intake from grains, 30% from vegetables and beans and 30% from vegetables and beans and 20% from fruits20% from fruits

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Gut flora

Unique internal eco-systemUnique internal eco-systemGI tract houses several trillion bacteriaGI tract houses several trillion bacteriaBad ones-Bad ones-

Clostridia, staphylococci, vibrionaceae Clostridia, staphylococci, vibrionaceae and and Ps. AeruginosaPs. Aeruginosa

Good ones- Lactobacilli Good ones- Lactobacilli andandBifidobacteria Bifidobacteria are main colonic bacterial are main colonic bacterial

speciesspecies

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Prebiotics are dietary components that Prebiotics are dietary components that promote the growth of probiotics. promote the growth of probiotics.

Probiotics and prebiotics are the main dietary Probiotics and prebiotics are the main dietary approaches to selectively influence the growth approaches to selectively influence the growth of beneficial bacteria.of beneficial bacteria.

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Probiotic

A probiotic is a live bacteria contained in a food (e.g. A probiotic is a live bacteria contained in a food (e.g. functional food such as yogurt) or a food supplement functional food such as yogurt) or a food supplement which beneficially affects the host by improving its which beneficially affects the host by improving its intestinal microbial balance.intestinal microbial balance.

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Fiber First DietAdultAdult ChildrenChildren

Total Dietary Fiber 31gTotal Dietary Fiber 31g Total Dietary Fiber 20gTotal Dietary Fiber 20g

BreakfastBreakfast

Wheat Bran Cereal (8g)Wheat Bran Cereal (8g) 2 cup wheat bran cereal (4g)2 cup wheat bran cereal (4g)

1 fruit (4g)1 fruit (4g) 2 fruits (2g)2 fruits (2g)

1 slice whole wheat toast (2g)1 slice whole wheat toast (2g)

LunchLunch

2 slice whole wheat bread (4g)2 slice whole wheat bread (4g) 2 slice whole wheat bread (4g)2 slice whole wheat bread (4g)

1 fruit (3g)1 fruit (3g) 1 fruit (3g)1 fruit (3g)

SnackSnack ½ cup fruit (2g)½ cup fruit (2g)

DinnerDinner

1 cup vegetable/ legume (4g)1 cup vegetable/ legume (4g) ¼ cup vegetable/ legume (1g)¼ cup vegetable/ legume (1g)

1 baked potato w/skin (4g)1 baked potato w/skin (4g)2 tomatoes (1g)2 tomatoes (1g)

1 baked potato no skin (2g)1 baked potato no skin (2g)2 cup fruits (2g)2 cup fruits (2g)

1 cup lettuce (1g)1 cup lettuce (1g)